Friday, 19 February 2010

Authors' letters of support for Medical Hypotheses

I have received more than one hundred and fifty individual letters of support for Medical Hypotheses in its current form, mostly from scholars who have published in the journal in the past.

I am extremely grateful to all of these scholars for their support – I have answered all the letters individually, and the majority of these letters have been forwarded to Elsevier (the publishers of Medical Hypotheses).

Below I have published (with authors' permission) a selection of these supportive letters.

These published letters were mainly chosen from among those which contained relatively detailed personal information about how Medical Hypotheses has ‘made a difference’ to the career and work of these specific people.

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78 Barrie St
Kingston, Ontario
Canada K7L 3N6

Chris Lloyd
Vice-President of Health Sciences Journals
Elsevier

Dear Chris Lloyd

We write in support of maintaining the status quo at Medical Hypotheses. This fascinating journal fills an important function in the world of medical science. It offers a forum for scientific ideas—hypotheses--, which spark new questions and perceptions to orient future enquiry. The scientific community has been ably served by editors David Horrobin and Bruce Charlton.

Long aware of the journal as a dignified space for theoretical ideas, we were fortunate to have our paper on music memory and dementia published in Medical Hypotheses in 2005. This paper presented two hypotheses related to evidence that may have been familiar to caregivers of people with dementia, but it had been little problematized by the scientific community. The publication helped to draw attention and funding to a new research project for us that has since resulted in controlled trials, leading to several other peer-reviewed research papers, collaborations, and conference presentations.

Our Medical Hypotheses paper was one of the first scientific publications on this topic. It preceded the recent, dramatic rise in popular interest in music and the brain, exemplified by the famous book Musicophililia of Oliver Sacks, who cited our MH paper. We were honoured to have been selected for the David Horrobin prize and will continue to acknowledge this award with gratitude and pride regardless of your future decision concerning the editor and the journal.

Regarding the controversy that has led to your deliberations: one of us (JMD) is a hematologist and medical historian, long aware that Peter Duesberg has been a denier of the HIV hypothesis of AIDS etiology for two decades or more. His views are provocative and extremely useful in teaching students. It is not necessary to agree with him to heartily defend his right to air his reasoning in a courteous manner and in appropriate fora. We feel that the opinionated responses of readers who disagree with an author are not a reason to alter the trajectory of the entire journal.

If it emerges that Duesberg’s paper erred beyond his minority viewpoint to actual errors—be they deliberate or accidental, a signal comparison can be made to two leading medical journals. Medical Hypotheses would have been no less a victim or a wrongdoer than the distinguished entities The Lancet and the New England Journal of Medicine.

Earlier this month, Elsevier’s flagship journal The Lancet withdrew a 1998 paper by Andrew Wakefield et al. that helped foster the now discredited theory linking autism and MMR vaccines. No one has called for the alteration of Lancet. Indeed, the issue has drawn attention to the preeminent leadership role that The Lancet plays in the dissemination of knowledge and ideas.

Similarly, in 2000 the New England Journal of Medicine published a peer-reviewed paper that strongly supported the use of rofecoxib (known as Vioxx®). Later it emerged that the paper had suffered improper industry interference and failed to declare a treatment-related death. The drug was taken off the market in 2004. Considerable discussion surrounded the editorial responsibilites for the 2000 article when the flaws came to light in 2005. But no one called for the New England Journal of Medicine to be altered in any way. Jeffrey Drazen is still its editor-in-chief.

The scientific world is a global epistemic community where ideas should be openly expressed and debated. Elsevier can be proud of the record of Medical Hypotheses and the unique theoretical contributions it offers to this community; and it should be grateful to the fine tradition established and maintained by its editors.

This is now the leading theory to explain SIDS (see my leader in the Lancet 2008: Morris JA, Harrison LM Sudden unexpected death in infancy: evidence of infection. Lancet 2008; 371: 1848 - 53.) The Medical Hypotheses paper and the idea were quoted and were influential in four high profile cases at the Court of Appeal i.e Sally Clark, Angela Cannings, Donna Anthony and Lorraine Harris. The idea is about to be played out once more at the Court of Appeal in March when the conviction of Karen Henderson is under review.

We are now in a position to prove or disprove the idea using the new science of proteomics. The proof or the disproof will depend on data and will appear in a conventional peer review journal. But the idea comes before the proof, in this case many years before the proof, and we need journals that will publish at the idea stage.

I should also add that the only time my work has been quoted in Minerva (BMJ,most read bit) is when I have published in Medical Hypotheses.

My rule is if you want to enhance your CV and research score go for a conventional journal with a high impact factor but if you want to say something important, interesting and exciting which is likely to be noticed - go for Medical Hypotheses.

I am alarmed to find out that Medical Hypotheses is under threat of dramatic, and in my mind, destructive changes. As a four-time author in this journal, I know first-hand how useful it is in generating new hypotheses that other journals would not publish.

Medical Hypotheses sits at the cutting edge of science, because it announces to the broader scientific community original ideas that may be worthy of further investigation. The papers I wrote generated much publicity, both scientifically and in the lay press.

For example, if you google the following words you will receive over 9000 hits: spangler, manganese, shower. These Google postings relate to the study I published that received world-wide publicity, and encouraged manganese scientists and regulatory agencies to rethink the safety of manganese in public water supplies (Elsner R, Spangler JG. Neurotoxicity of Manganese: Public Health Danger in the Shower? Medical Hypotheses 2005; volume 65; e-release May 21, 2005.)
I feel quite certain, because of the radical nature of my hypothesis—one that is difficult to test but needs to be considered globally since manganese is increasing in the environment from its addition to gasoline—no other journal would have been willing to accept it.

Indeed, this study has led to other peer reviewed studies which I have written regarding environmental manganese (Spangler JG, Reid JC. Environmental Manganese and Cancer Mortality Rates by County in North Carolina: An Ecological Study. Biol Trace Elem Res. 2009 Jun 4. [Epub ahead of print]; Spangler AH and Spangler JG. Groundwater manganese and infant mortality in North Carolina Counties. Ecohealth, 2010; in press).

Science needs radical hypotheses, forward thinkers, scientific risk-takers. This is how science has always made its greatest advances (think: Einstein). While I am no Einstein, nonetheless the articles which I have published have sparked interest in a wide variety of disciplines. The same is true for other articles in Medical Hypotheses.

Peer reviewed journals are by nature conservative. They worship at the altar of p<0.05, at the throne of the randomized placebo controlled clinical trial. However, innovative ideas are often difficult to test readily. Peer reviewed journals demand data, even when data cannot be obtained. In fact, data might never be obtained unless someone publishes the novel idea in the first place. Clearly, an editorially-reviewed outlet—willing to take risks—is very much needed in science.
I hope the publishers will recognize the jewel they have in this remarkable journal. I hope they will continue to publish it in its current editorial format.
This simply is a matter of scientific advancement.
Sincerely,
John Spangler, MD, MPH
Professor of Family Medicine
Wake Forest University School of Medicine
Winston-Salem, North Carolina 27157
Phone: 336-716-2238
*
On Sat, 16/1/10, Paul W. Sherman wrote:

Under your editorship, Medical Hypotheses has become an important vehicle for publishing exciting new ideas and information that is helping to shape the directions of medical research.

My own special interest is in Darwinian medicine. This exciting, new, interdisciplinary field takes an evolutionary perspective on human health and disease. Practitioners ask whether behaviors and symptoms that traditionally are considered pathological might have evolved to serve useful purposes. Whereas traditional medicine focuses on how symptoms are brought about (their underlying mechanisms) and designs more effective ways to eliminate them, Darwinian medicine focuses on why the symptoms occur in the first place (their reproductive consequences) and whether it is advisable to eliminate them. These approaches are complementary, not mutually exclusive. The promise of Darwinian medicine is that it will lead to better-informed medical practices because, to fix something as complex as the human body, it is essential to know what each of its parts was "designed" (by natural selection) to do.

Medical Hypotheses is - literally - the only journal where Darwinian hypotheses for medical phenomena are routinely presented for rigorous evaluation. Cancelling the journal, or massively altering its focus and editorial policies, would potentially deprive both the medical and biological communities of their only existing forum for interaction. I hope that such a serious loss can somehow be averted.

It is with great regret that I learn of the plans to change Medical Hypotheses. I have the most highest regard for your process and a few years back, as young researcher with little experience, you gave me the change to publish my ideas. Now, more than 130 peer reviewed articles in ISI rated journals further, I think back and have to thank you for giving a young, wide-eyed researcher a huge opportunity!

As a young clinician-scientist beginning my career, I wanted to extend my personal thanks to you and to Medical Hypotheses for the unique service I feel it extends to the scientific and medical community. As I built upon my graduate work on ion channel physiology to explore a realm of possible drug design strategies (known as rational promiscuity), I discovered that journal after journal would respond to my submissions with "...interesting, but too theoretical, and we do not take unsolicited hypothesis papers". I estimated that I had read for this project about 1000 papers over 10 years collecting the data necessary to put forth a series of 4 hypothesis manuscripts. This work was mainly undertaken over the years of medical school, internship, and residency, when there is little time for experimental science. This "gap" in the training of MD-PhDs is the continued subject of debate, a limbo in which we are often too junior to have a broad reputation required for hypothesis publishing, but we are also ripe with ideas that may bridge clinical and basic sciences.

I am deeply thankful that the first 3 of these papers have been published through Medical Hypotheses, the only dedicated publication for hypothesis in medicine. I have received many contacts from around the world for reprints, but more importantly, the ideas are now easily available through PubMed and other databases, for anyone to consider. Having a platform to construct and share these thoughts has proven invaluable, and has laid the groundwork for finally initiating experiments (which are very costly) to generate data of my own to begin testing the hypothesis. I am as proud of these papers as any experimental paper I've published, and in many ways they were in fact more challenging.

I can think of no better evidence for the lack of understanding of the importance of this Journal than the demands for restructuring based on a visceral response to an unpopular hypothesis. Science is uniquely poised to remain agnostic to politics - at least in theory. Unlike any other endeavor on the face of the earth, doubt and uncertainty are the foundations of progress, and diversity of experimental and theoretical approaches are the currency driving this progress. It is by no means a perfect process, and the road is littered with countless examples of "proof" later considered folly - and vice versa. But any thoughtful academic will understand that this is part of the magic of science. Perhaps the outspoken critics would do well to read some of the history of science and medicine, in particular the cogent accounts provided by Ramon y Cajal or Kuhn or Feynman. While I think there is little room for the censorship proposed by critics, I do understand that this is an area of uncertainty crossing boundaries into public policy and public health. But as much as I dislike cliches, images of babies and bathwater are unavoidable when the response to a disagreeable topic is to completely abolish the journal as we know it. One alternative approach would be to claim that the Journal should have formal peer review or else be removed from PubMed listing - but by this logic, every PNAS paper directly submitted (ie not reviewed externally) should be removed as well (and some might agree with that; I would not). Another approach would be that the format remains intact, save that certain topics should be censored, but surely proponents of this angle would concede the impossibility of deciding on the special list of prohibited topics. But anyone submitting the argument that peer review somehow prevents "bad science" from being published simply hasn't ever attended a journal club meeting. That certain topics could be used for nefarious reasons by ill-intentioned individuals is, in my view, completely irrelevant, as there is quite literally no prevention against that possibility in this information age. Unfortunately, those easily fooled by such devious efforts are not likely to be among those who understand the difference between good and bad science (which is not always straightforward even for seasoned investigators). Perhaps a format in which public comments (positive and negative) could be attached to articles via the MH website would be a reasonable compromise.

My intention is to offer neither a philosophical "it's-all-relative-so-leave-us-alone" argument, nor an existential "all-human-thought-is-absurd-so-leave-us-alone" argument, nor an aloof confidence that "science-will-work-itself-out-so-leave-us-alone" (although I admit personally to all 3 feelings). What we have are very tangible and very practical arguments in favor of maintaining the status quo of MH. The transparent policies, long history, and unique platform for sharing ideas with a community hungry for new and imaginative vistas of investigation, are all evidence that Medical Hypotheses stands alone in serving a critical (and largely unmet) need in the research community: the dissemination of medical hypotheses.

From what I have been through as an author struggling to publish my work, I strongly and fully support the policies of the journal Medical Hypotheses, which was established 34 years ago by Dr. David F. Horrobin.

During my time at the Oxford University, UK, I formulated my hypothesis of the pathogenesis of Alzheimer disease in 1992. I submitted the work to eight journals including Nature, Science, NEJM, Trends in Neuroscience, J Alzheimer's disease, Brain Research. However, not one journal after peer review was willing to accept my work for publication because the expert reviewers favored the prevailing hypotheses in the field at the time (please see one of the comments from the editorial office of NEJM as evidence in the attachment.)

I finally submitted the piece of work to Medical Hypothesis, encouraged by the policies that the founder and editor Dr. David F. Horrobin established in 1975. It reads: “Scientific progress depends on the existence of creative tension between ideas and observations…There is neither free presentation of new ideas nor open criticism of old ones. Outdated concepts can persist for prolonged periods because the evidence against them is scattered through hundreds of papers and no one is allowed to gather it together in one article to mount a sustained attack.” “I will publish papers from anyone regardless of whether they have done experimental work in the field, and regardless of the reputation of the authors or the institutions from which they come.”

I didn’t receive any response from the Journal for three months after my submission, and I assumed the reviewers were unwilling to say yes or no. I have been ever so grateful to Dr. Horrobin who reviewed my manuscript himself and accepted it for publication in the journal Medical Hypotheses. This hypothesis has been later refereed as one of the four leading hypotheses in the field (Progress in Neurobiology 52(6):511-535, 1997).

Invigorated by the policies of the Journal Medical Hypotheses, I’ve published a total of seven hypotheses which were rejected by other journals. One hypothesis of the possible cause of Gulf war syndrome received special attention after the publication from the Pentagon in the US (please see attachment) and has been proved completely correct ten years later in an article published in PNAS, 2008, 105(11):4295-300. Scientists all over the world have cited my hypotheses published in Medical Hypotheses up to this day of 2010. I’ve received a considerable amount of invitations to contribute articles, and have been regarded as an opinion leader and rising star whose ideas would influence drug development and management in the field in the next five to ten years (please see attachment). The issue of the unsatisfactory outcome of the use of AChE inhibitors in the treatment of patients with Alzheimer’s disease was raised by me in my first and subsequently published hypotheses and now has become one of the most popular medical news stories of 2009 in MedscapeCME (information is enclosed in the attachment.)

Like most authors and medical scientists I truly wish my painstaking research to be known and to have a positive impact on the care of patients and on medical science. However as a matter of fact, it will not be possible for researchers like me to imagine and to hope that my hypothesis will be published and disseminated in the world, if there were no such journal with policies like those of Medical Hypotheses.

In the name of science I believe it will be a shameful and unforgivable mistake, if the publishers change the unorthodox journal of Medical Hypotheses into an orthodox one.

I have been informed that Elsevier is currently thinking about destroying the fundamental idea – editorial review – of the renowned journal Medical Hypotheses. PLEASE DO NOT!

Please do not regard my message not just as another email from a Medical Hypotheses-author: My research topic is technical sciences and I work in a nuclear physics institute.

It is “Publish or Perish” in the scientific world today. This forces researchers to submit hundreds of papers during their career. This, on the other hand, forces peer-reviewed journals to be more and more strict about accepting the researchers’ papers. This leads us into the completely wrong direction, because reviewers will only recommend papers for publication that are fully consistent with their view and only, if the study is absolutely complete or even overcomplete. Sometimes it is not a question of laziness to complete a study, sometimes it is simply impossible due to a lack of instrumentation, personnel or money. Medical Hypotheses is the ONLY high-class forum for making a good idea accessible to a broader audience – especially those ideas that could not be completed for some of the mentioned reasons.

Medical Hypotheses papers are read by the entire scientific community, not only by the medical one. And, of course, some of them make us laugh. Others make us shake our heads. So what? In a recent issue of Chemical & Engineering News (C&EN), which is the number one news platform for chemistry, my Medical Hypotheses paper of last year has been highlighted. I concluded the interview with C&EN with the following sentence.

"I truly regret that technical sciences do not have a forum for radical and cutting-edge ideas on a comparable level as Medical Hypotheses," Steinhauser says. "If we fail to investigate something, our best ideas often remain unpublished."
In fact, Elsevier should not cease Medical Hypotheses (neither completely nor in its present form) but launch MORE journals of this kind! Start with chemistry today, not tomorrow!

I am surprised to hear about the proposed changes for MH. I have published 2 papers in the journal. These would probably have been blocked by peer review carried out in the current peer reviewing culture, which tends to discourage lateral thinking and inventiveness. I say this as a clinician and researcher who is involved in peer review both as an author and a reviewer, so I have no particular axe to grind. There needs to be a respected medium for hypothetical papers, and in my opinion MH meets the need very effectively. I am entirely happy for you to hand these comments on to the publishers.

The idea that Medical Hypotheses will turn into a peer reviewed mainstream journal saddens me extremely. I wish I had a good idea to prevent such and if you have a good idea what to do, please let me know. There were times I felt i should leave research alone as there is no reviewer without hidden thoughts so far. Publishing your research is too complicated and it should be left to the reader to judge the manuscripts in the end. A "quality assessment" by peer review by anonymous reviewers would be poison for a highly constructive journal as Medical Hypotheses.

An open letter to Elsevier
Medical Hypotheses and its editorial policy: stet

Dissent is also a meaningful contribution to discussion: there can be no debate if there is no ‘against’ to the ‘for’. The medical world has always been and in the light of the ‘attack’ on Medical Hypotheses’s editorial policies, will continue to remain cocooned in its own ivory tower of supercilious self righteousness, using its arm-twisting others into kowtowing to its own definitions on journalistic ethics and privileges. The general and all-pervading intolerance to opinions or dissent or different from ‘acceptable’ self-proclaimed norms’

Merely because someone pronounces something unpalatable or contrary to popular trend about an infectious disease, and finds an appropriate forum to air his views, does not make his opinion gospel. Yet, to single out the editor or the journal for daring to open its pages to such radical views, is not ethical or cricket. Of recent development is the exposure of how really different the ground situation actually was during the so-called pandemic H1N1. While me-too editors were going overboard to touting dire straits, wily- nily jumping into the welcome home net spread wide by avaricious drug cartels.

Much brouhaha and tomtoming on the infallibility and merits of peer review and its absence in MH has accompanied the stifling and strangling of free and fearless editorial practices of MH, autocratic though they may appear at times – the fact is, there is nothing much that is sacrosanct about peer reviewing as a quality check for publishing: I myself have had my submissions politely rejected by anonymous reviewers of one journal, only to see that very paper published in yet another’ peer reviewed’ journal a while later. How may in the medial world will honestly declare they too haven’t experienced this irony? Do editorial boards of the so-called peer reviewed journals know how many of the papers their own reviewers ‘passed’ had been outright rejected by their own ilk elsewhere?

If a paper is lacking in conviction or content then it should be unsuitable for exposure to a wider audience. Yet, time and again, all of us know, that being rejected by one set of reviewing ‘peers, implies resubmission and acceptance in another equally popular or patronized journal: If the much vaunted peer review system was as holy a cow as assumed to be, how come there so difference and disparity in submission quality assessment between one journal and another?

If your name is Casca then you will be hanged for your bad verse: Strange logic this in a world moving towards open access along the free information. I myself, as author or co-author have had the mortification of having ‘accepted peer reviewed’ articles kept in permafrost by editors, neither seeing them in print nor having them released from the copyright transferred clause I readily agreed to sign. The only reason for the cold storage of at least one among such papers in question is, I deduce, because it says something at variance with ‘acceptable’ regimens and presents radical observations on lowering viral loads in HIV patients. Could is be that too many megabuck toted apple-carts would go cart-wheeling by new and effective cost-friendly initiatives on AIDS control.

Medical Hypotheses and its Editor has allowed me, at no price, to present a few observations and theories over the years, many of which I could not pursue meaningfully to conclusion for want of infrastructure and funding. That some of my publications in MH have even been cited or referred to in indexed journals is itself a telling commentary on how hollow the sanctity of peer review actually is ( incredibly a few editors even request the submitting author to suggest reviewers or choose tem from a panel provided: how much lower can the system go?.

As a novice editor of a nascent third world based open access journal, I humbly implore Elsevier to leave Medical Hypotheses and its editor/s pursue their goal of providing space to new, novel, controversial or dissenting opinions. Stet is a term that editors often use, maybe it is time publishers used it to. Stet, leave it as it was.

Dear Bruce – This is outrageous! I have posted a comment on the Times Higher Education website stating, among other things, that I will never again submit a manuscript to “Medical Hypotheses” if Dr. Horrobin’s original intent is dishonored and you are replaced as Editor. People who believe that the Medical Literature should be Holy Writ, purged of all Error , evidently have no understanding of the scientific process, and don’t merit our respect.

Ironically, an old scientific friend of mine, who died this last year, was a friend of Duesberg and respected his views on HIV. I could never agree with him on this, of course, but I respected the courage of his contrarian convictions, and I didn’t let it ruin our friendship. It took guts to publish Duesberg’s perspective, and I admire that. The people who took exception to this should have simply sent cogently argued rebuttals to MH, which you no doubt would have been pleased to publish as well. In my view, people like Duesberg and my late friend perform a service by emphasizing that our understanding of HIV’s physiological impact remains far from complete.

I suppose I have a hatred of all Dogma – scientific, religious, or otherwise. The last thing we need is for all editors of medical journals to function as Mini-Popes!

Please keep us updated on the evolution of this controversy, and I will do what I can to make my views known.

I have been one of the extremely lucky people to be published by you, essentially put on the map intellectually by you, for which I can never thank you enough. Dr. Walter J. Freeman, even though now in his 80's, has been corresponding with me for at least 15 years, and his comments in support of my new book for professional caregivers of young children, including teachers and therapists, provide the imprimature for the book, just as your journal provided support for my papers: The Scribble Hypothesis and A Theory of Marks and Mind. The book Saving Literacy itself, of course, rests upon my two papers published via Medical Hypotheses Journal. I am also publishing a companion book at the same time for parents, HandMade Marks.

Your publishing of my theories and research was critical to my confidence and to my authority as an innovative theorist and practitioner around children's intentional marks.

It would be a terrible shame for Medical Hypotheses Journal to be destroyed after 34 years of important support and publication.

It's a shame that this unique journal has to face these problems. I would like to say that I consider it very important for the scientific community as it s one of the few dealing with theoretical issues in the biomedical sciences

While nobody questions theoretical physics eg radical ideas in cosmology(that can not be experimentally tested),seems that this is not the case in the biosciences.

In my particular case I published one paper dealing with a model of cellular aging that was selected as suggested readings in GeneReviews. This is an honour in such a competitive field.

I am very proud of it, and Medical Hypotheses gave me the opportunity
to publish it.

Of course I also believe that how to evaluate the best possible way special papers related to public health problems will be a challenge for the editors in the future .

To summarize I believe that Medical Hypotheses is a very important journal and its phylosophy should be kept intact.

I really wish the best for Medical Hypotheses, and I hope we can celebrate its 100th aniversary

This is extremely discouraging news. As you know, you published The Case Against Antipsychotic Drugs, and no peer-reviewed journal (often supported by drug-company ads) would have publshed that article. Yet I know that article made an impact, including on some who teach psychopharmacology. Peer reviewed journals allow for scientific reviews to proceed along narrow corridors, and they generally exclude truly novel and fresh thinking. Your journal made that possible.

Please pass on my comments to Elsevier. If they change Medical Hypotheses into one more peer-reviewed journal, science, medicine and the public will all suffer a loss.

I have published two papers in Medical Hypotheses. I have also published in journals like the New England Journal of Medicine, JAMA, Biological Psychiatry, Psychiatry Research, and Journal of Nervous and Mental Diseasee, and many other highly reputed journals. I am a physician and a scientist with a solid publication history. I am editor of three e-journals in the field of mind/brain science. In my publications in Medical Hypotheses, Consciousness and Synchronicity, was the first publication to describe quantum evolution of brain states by collapse of the wave function, now a leading theory of consciousness and the subject of at least 3 books. The second, Virtual Brain States and Non-locality of the ERP, was a seminal paper and has lead to a number of subsequent investigations, and was state-of-the-art data driven. Unfortunately, these papers have been rarely cited, although many have used the ideas. You can't copyright ideas, so there is nothing I can do.

Medicine needs an outlet for new ideas, however radical they may be, as long as they are supported by evidence or are logical solutions to theoretical problems. I would hate to see us lose this valuable outlet. Science, in my opinion, has a philosophical bias towards untrenched ideas and paradigms, which may be incorrect. The history of science is replete with revolutionary and paradigm changing ideas that have been scorned and rejected in their own time. A hypothesis is, by definition, unproven, and for every new hypothesis that proves to be correct there are many that do not. It is difficult to publish purely theoretical work, especially if they are interdisciplinary, although I have published many such papers in reputable journals. If there is no outlet for new medical hypotheses, all of medicine and science will suffer as a result.

I hope that Medical Hypotheses can continue with its mission unabated.

I published my first paper in Medical Hypotheses in January 2000, after having published many other scientific papers in many journals, all of which were peer reviewed. These included six Elsevier Journals. I have reviewed hundreds of papers for many journals, including various Elsevier journals.

That first paper has been cited 57 times during the past nine years, according to Google Scholar. It has led to my publishing a series of 22 papers and a book, entitled "Explaining 'Unexplained Illnesses'" most of which have also attracted substantial numbers of citations. The area of research that I have been pursuing over the past decade, all derived from that original paper in Medical Hypotheses has attracted much attention. I am currently scheduled to give 12 invited talks in the U.S. and in five European Countries between March and June of this year. Quite a number of these are prestigious talks, including an all day workshop for German physicians in Berlin scheduled to correspond to my visit; a talk at a special meeting on multiple chemical sensitivity in Paris also scheduled to correspond to my European visit; a 4 1/2 hour series of talks at the Royal Society of Medicine in London, also scheduled to correspond to my European visit. I have been asked to write a review, I would argue the definitive review, on multiple chemical sensitivity, a review that came out 2 months ago, in a prestigious multivolume reference work for professional toxicologists. All of this and much more is essentially derived lineally from that first Medical Hypotheses paper.

There is a need for a journal like Medical Hypotheses and it would be tragic, in my view, to destroy a journal that is performing a valuable function for the science of medicine, by converting it into something very different from what it is now. Medicine is a field that is dominated by vested interests, typically by well funded pharmaceutical industries, and is much less scientific than it should be because of this. This has been clearly documented in books written by Dr. Jerome Kassirer and also Dr. Marcia Angell, both former editors of the New England Journal of Medicine, who should certainly know this area well from their periods as editors of the most prestigious medical journal. The dominant role of vested interests in medicine has led to a world wide crisis in medical care, and while this crisis is most evident in the U.S., as shown by the recent debates on medicine in this country, it is a major problem all over the world. In this type of situation, a forum for documented opinions that is more open to those who hold views that dissent from those of the dominant vested interests is essential. If Medical Hypotheses is converted into a journal where there is a list of excluded topics, that would be unacceptable censorship by Elsevier, in my judgment.

I would like to add a comment on the issue of peer review. I published my first paper in 1968, some 42 years ago (in an Elsevier journal, by the way) and have been observing the functioning of peer review over that extensive period of time. Over that time, the peer review system has deteriorated substantially for two distinct but interrelated reasons, both related to the pressures and difficulties of maintaining research funding on the part of potential reviewers. One is that individual scientists have become highly focused on very narrow areas of science, with such narrow focus being viewed by many as essential to maintain funding. As a consequence of this, scientists are much less able to peer review papers that are outside their very narrow range of expertise. The second is that with much pressure on the time of scientists to maintain funding, they are much less willing to spend their time researching a paper in order to provide a competent peer review. Rather papers are much more often reviewed by peer reviewers who have a vested interest in determining whether the paper is published or not, rather than providing a scientifically objective peer review. This is a great challenge for editors who are trying to keep their journals truly scientific, as opposed to simply reflecting some vested interest position. There have been, as I think you know, whole journals that openly or covertly state that they are journals supporting some industrial line, rather than genuine scientific journals. There is some stunning junk published in peer reviewed journals, things that should never have been published if the paper had been properly reviewed. And this happens in the most prestigious journals as well as in more pedestrian ones. The fact is that peer review has very substantial flaws and there is an advantage to having some journals that are editorially reviewed - at least then you know who to blame when something slips through the cracks. The flaws of the peer review system are likely to impact a journal like Medical Hypotheses more than other journals - how do you get people to effectively peer review a paper that is truly novel?

I think that for all of these reasons, Medical Hypotheses should be viewed as a successful journal that is currently performing a valuable function to the scientific and medical communities and should be left to pursue further successes with its current structure. If Elsevier feels otherwise, then I would ask Elsevier to email me directly and tell me why.

After reading reactions regarding the publication of a paper by Prof. Peter Duesberg on Aids in Medical Hypotheses I have found myself in a deja-vu situation. Humans are alike everywhere. All is the question of scale. Anyone playing not with us, ought to be an enemy.

First, regarding my conflict of interest. As a young person trying to become a scientist in a war thorn country, I have published first papers outside Croatia in Medical Hypotheses in 1995. Since then I have published in several other journals with IF from 0.2 (papers in Colegium Anthropologicum) to 4.9 (a recent e-letter in The Oncologist), but at least annually I have always prepared something for Medical Hypotheses.

The reason for my loyalty to this Journal is simple. I find the basic concept intriguing for any free thinking person. During last years, as a reviewer for several Croatian and European journals, I have read several very malicious reviews aiming not to help the authors, but to make them realize just how pathetic was their submission. So, I believe that both the peer review approach and the editor review do have their limitations. The peer review can be im proved only with a large number pool of well-categorized reviewers, random assignment of papers to three reviewers and gradual exclusion of those reviewers that are repeatedly opposite to other two reviews. Nobody does that, since it would take to much money and time.

If the only real fuss regarding the content of a published paper in this Journal happened only once in 34 years, it would mean that we are talking about an extraordinary accurate journal with a respectable citation rate. People are reading, some of them are even citing the papers from it and there seems to be no problems. The reason for this smoothness is the journal name, evident in any citation: Medical Hypotheses. With this name no false argument is being made, authors are speculating on
available facts and anyone can take it as plausible or not. Nevertheless, often the papers are interesting to be read. Readers recognize it and no hard feeling can normally develop.

So, it must be the topic in the paper, not the Journal itself. I have no detailed knowledge regarding AIDS, but the idea in the paper must be an important taboo, otherwise more than 10% of papers in Medical Hypotheses would be considered controversial. With so much attention, it has to do something with the money, at least this is the way in the part of Europe I live.

Since this journal is unique by its profile, impact and tradition, every intervention in its concept would move as one step further to Lysenkoism, or other, more modern type of orthodoxy in science. Without this Journal, a not so small tribe of free thinkers in biomedicine would have to go elsewhere or to stop theorizing and think only on routine. Is this a future that we want, or is it made for us by those who know better? I hope not.

I have just received an e - mail from Dr. Bruce G Charlton regarding the " Unclear outlook for radical journal as HIV/Aaids deniers " which evoked an outrage of protests/ support views on whether or not to decide that Medical Hypotheses be changed to a new formate, this time including peer evaluations of scientific articles submitted to the Editor of the Journal. Many of the comments made expressed concern that establishing a peer review system might be counter productive since " wild and innovative ideas " which are not in line with the dogmas set by investigators who believe they " hold the ultimate truth in science ", will never be published.

As a contributor to " Medical Hypotheses ", I strongly believe that at least ONE out of the thousands of regular peer evaluated journals which exist today, should be left alone to serve as a spokesman for those articles which will definitely be rejected if submitted to a peer evaluated journal.

Let me brief you about the ordeal I had gone through during my long academic career which will clarify why I think that Medical Hypotheses should not be touched.

The following is a clear example why ideas which are not in line with accepted dogmas should have an appropriate independent forum of expression.

For years I have been struggling with Editors trying to convince them to instruct authors working on the mechanisms by which cationic peptides kill bacteria, to cite a large numbers of my publications on the subject. The accepted dogma today is that cationic peptides kill bugs by permeabilizing their outer and inner membranes rendering them non -viable. On the other hand we have argued that cationic peptides might ALSO kill bacteria by activating their endogenous autolytic wall enzymes ( muramidases) causing bacteriolysis and cell death. Furthermore, although one of the leading investigators finally mentioned in his peer reviewed article that the bacteriolysis concept, is valid, but surprisingly ignored any of my publications on the subject. Only " God " knows what had motivated this author to intentionally ignore the bacteriolysis concept, and why, the Editor of the journal had failed to deal with this issue. Such an INTENTIONAL suppression of " non orthodox" ideas is a setback to honest SCIENCE and the only crime the dissenter had committed, was that he " thought differently " !!

To my rescue came the Editor of Medical Hypotheses who in 2004 ( volume 62 : 367 - 374 ) had accepted my overview article entitled :
" Bactericidal cationic peptides can also function as bacteiolysis- inducing agents mimicking beta- lactam antibiotics ? it is enigmatic why this concept is consistently disregarded" . As of today, this article had been cited 33 times.

More recently, I have been invited to comment on a key review article on bacterial killing by cationic peptides submitted to Experts Rev Anti Infective Therap. Once more I found out that although the same author had again mentioned bacteriolysis as a possibility, he failed to cite our papers on the subject. Justifying my criticism, the editor of the journal invited me to compile a large polemic essay on the subject in order to bring to the attention of readers that there might be an additional mechanism of bacterial killing Please refer to : Are cationic antimicrobial peptides also " double - edged " swords ? Ginsburg I and Koren E, 2008 Volume 6:453- 462.

Taken together, in order to avoid either unintentional or intentional disregard for publications which do not coincide with the main stream of thoughts, we badly need " watch dogs " who will allow those authors whose papers might either be abused or rejected by PEER EVALUATORS , to present their ideas. This is why I strongly oppose to any attempt to change the current policy of the Editorial Board of Medical Hypotheses. Needless to say that any paper submitted for publications to any journal should be supported by convincing experimental data.

I shall greatly value your comments and suggestions and am looking forward to hear from you soon.

Dear Mr. Lloyd:
The editor of Medical Hypotheses recently made me aware that Elsevier had intended to radically alter the way he would be able to select articles for publication. Recently, two controversial, politically-sensitive, and probably scientifically inaccurate articles were withdrawn from the journal by your publishing company. No journal is immune from such errors and even the prestigious peer-reviewed journals Science and Nature have had to withdraw published articles because of fraudulent data or conclusions.
The basic tenants for article selection by Medical Hypotheses are unique in that they permit the dissemination of new paradigms of thought, more or less supported by real data, but nevertheless thought-provoking. Since Dr. Charlton has become editor, the quality of articles has progressively improved from those that were largely nutraceutical in content to those with more diverse subjects and authors from many disciplines. The progressive increase in the Impact factor has supported this statement.
It would be eminently sad to see the one of the very few beacons that welcomes radically new hypotheses and often serves as the only opportunity for such ideas to be widely shared by the world’s scientists to disappear from the publishing scene. Of course some of the articles might be considered trivial or even outrageous, but these are certainly not the rule. There are others that offer real food for thought and have stimulated new paradigms between disciplines of science and medicine.
I, and many of my colleagues, implore you and Elsevier to resist political pressure and maintain a steady support of Medical Hypotheses in its current form for the selection of articles. The editorial comments by Dr. Charlton have been particularly stimulating and we look forward to any issue that contains them.

First, it has always been a challenge writing articles for Medical Hypotheses, as well as we had a great satisfaction enjoying the attention we had here in our local community.

So, we were pretty upset, when we have heard about the troubles You are going through.

We are a small group of people trying to make science, from a small country, with small resources. It is crucial for us to publish hypotheses which are we cannot investigate alone, sometimes there is a positive echo from abroad – and among others - Medical Hypotheses made it possible.

It would be wrong to change the editorial policy of this journal because it is unique. The feeling of freedom while expressing our ideas was priceless, reading the articles of others was rather an inspiration, and invitation to reconsider what is known, and what is not in a particular topic. We had never the feeling we were fooled by others with some so called - pseudoscience.

Of course, there are people who have a different opinion. Maybe they are afraid their ideas could lose their public ? Well, if those ideas are wrong - it will surely happen, but that is just the pure nature of science - checking ideas and concepts in the search for the truth.

We are just afraid how dangerous those people are, if they want to destroy a journal just because it has published some ideas out of present dogmas. Well, it seems to us that we all were fooled at school when we learned that the times of inquisition, Nazism, communism etc were behind us ...

Suppressing different ideas is a way straight into dark ages, and we hope You will find many allies in Your fight for the right thing.

I am an author who over the recent years published two papers in Medical Hypotheses. I and my co-author of these two papers highly valaue the editorial review policy of this journal and the importance of this journal.

I'm shocked to learn from Dr. Bruce G. Charlton, the Chief Editor of Medical Hypotheses, that Elsevier are considering major editorial changes to this unique and proven journal (over 34 years) which makes money for Elsevier, apparently due to one or two allegedly inappropriate papers appeared in Medical Hypotheses.

The vitality and longevity of this journal depends on the editorial review policy (choice)instead of peer-review. The latter process often suppresses new ideas and hinders scientific process.

I urge that the leadership of Elsevier weighs very carefully about the issues in front of them, be far-sided and tolerant.

I am confident that the readers of this innovative journal and the general public are smart enough to recognize an "inappropriate" article which now-and-then may appear in the journal. Throwing the baby out with the bath water would be a tragedy.

I have submitted a number of papers to the Medical Hypothesis journal Usually the approach has been for my students to learn to articulate their ideas in a publication prior to diving into a new study and then to follow with the results of their study and describe whether their hypotheses were correct. It has been a valuable learning tool and forum where ideas can be transparently proposed without the politics and games that are typically associated with the usual journals. Changing this format would be a shame and we would cease to submit manuscripts to this journal if it did change.

It recently came to my attention that there was a crisis concerning the journal ‘Medical Hypothesis’ because of the publication of an anti-HIV article without peer review.

My field of expertise is not HIV and AIDS, since I am a psychiatrist myself, so my opinion is based on principal values and not by specific events and facts.

My view is that although peer review is and should be the mainstream for scientific publishing (I am editor-in-chief of a peer-reviewed journal myself), it is today more than ever necessary to have a parallel open system (a minority of journals within the publishing system) who will function in a different way (no matter whether this would be 'arrogant', 'selfish' or 'fatally problematic').

The peer review system has the advantage of choosing 'good science' papers and acts as a quality filter. The same time it has the important problem that it suppresses radical and revolutionary and it tends to support the current view and interpretation of things and precludes breakthrough.

As an editor-in-chief myself, I know how difficult it is today to find reliable peer reviewers; as an author I often find myself in the position to respond to impossible comments by reviewers who obviously have limited knowledge of the subject they were asked to review. The publishing of a paper is based on the assumption that the authors are honest and have not fabricated the data (I think that this can not be verified for most of the papers submitted to a journal) and that the reviewers have no conflict of interest, they have sufficient knowledge of the subject (I doubt for most cases) and that they will invest much time to do a proper review (I also doubt they will). For prestigious journals these are often the case but there are important problems for the majority of journals.

Another important problem is that although innovation today can come from a limited sources, and one of these sources is interdisciplinary collaboration and carrying of innovations achieved in one field of science to another, most scientists and reviewers are either super-expert prominent scientists or undereducated technicians (I know first names in prominent journals who can discuss nothing more than the very papers they have published, they have no more than 2-3 years of formal training and they are asked to review papers on a regular basis because their general credentials are never shown anywhere).
I often wonder what happens to papers accepted with bonfire by the highest ranking journals; the vast majority disappear from the scientific thinking and their results are proved mistaken and misleading after only a few years.

To cut a long story short, the above are inherent problems of the peer-review system and the way research is conducted today. We don’t have a better way to regulate things and we are indeed not allowed to let the field of science to become chaotic; a field where any charlatan can do whatever he wishes and cause harm to humanity.

However, we also need to keep a small door open; we need to let new ideas and proposals to circulate uncensored. The word UNCENSORED is important. There are not many journals in the publication business that are serving this goal, and Medical hypothesis is one of them. Their function is important for the future of science, no matter whether there are problems from time to time. Science is a dynamic procedure. Its not only a matter of democracy in expression, it is a matter of keeping the horizon open for the future development.

In this frame, I consider an honor for Elsevier to have such a journal, the Medical Hypothesis, and I hope that in the future it will continue to serve the same goal and need of the scientific community.

I am a 34-years old medical doctor from Istanbul in Turkey, who published twice in Medical Hypotheses. My first publication was during the editorial period of Dr Horrobin in 2002 and my second publication was accepted by the editorial of Dr Charlton in 2007. My first publication gained attention of Professor Gerald F Joyce working on RNA evolution at the world-prestigious Scripps Institute with positive comments. My second paper gained attention of Bayer International and they decided to support a research study for testing aspirin effects to elevate fetal hemoglobin in attenuating the severity of thalassemia (** see below). Currently, I am giving lectures in a Molecular Biology Department of a private university and mainly interesting with molecular physiopathology of cancer, thalassemia and psychiatric disease; I wish to say couple words about the Elsevier's attempt to change the style of "Medical Hypotheses".

People often say that the worst thing, which could ever happen to a researcher is sacrifying a good idea to a bad experiment. I thing the worse probability is frequently happening to researchers from less-developed countries due to a simple fact: They could barely find equipments to test their idea. This can lead to several possibilities: I- Researchers from developed countries could reach to the searched fact in a short manner. II- The searched fact could be reached far later, since it might be overseen or neglected by researchers with more resources. III- A hypothesis, which might lead global benefits could never be tested, since it was the brain fruit of less-lucky geographies.

If "Medical Hypotheses" will be made a more orthodox journal, this could only lead to monotonization of scientific voice and opinion. Please let a journal to allow papers with little less orthodoxy, please let it to allow "more flying of ideas more freely". We have hundreds and thousands of journals of same style, same seriousness and same strictness. Diversity is the magic of nature and biomedical journal-dealing people are aware of "biodiversity", yet if they could have applied this principle to their own practice, this would very much change the pace of research benefits and its daily applications.

Dr Charlton (Charlton BG) seemed to contribute far enough to global research with an impact of 185 publications and 1109 citations in a 20 years period until 2010.

I support of his editorialship and I decline any strictness-type change in publication policy of Medical Hypotheses.

Hypothetical clues suggesting that 'AU' and 'UA' were the first 'beginning' and 'end' codons: is their ancient polymerase extant present as a protein domain fossil in reverse transcriptase and telomerase? Altinoz MA. Med Hypotheses. 2002 Jul;59(1):63-7.

I write in support of Medical Hypotheses as a non-peer reviewed journal.

Peer review works well for papers which seek to add to an existing body of knowledge. Peers are reviewing work which extends incrementally an accepted paradigm. Any radically new idea, however, by definition, breaks with conventional wisdom. Hence, there will not be a ready made group of peer reviewers conversant with the approach and easily able to assess the contribution. Moreover, ideas and interests go together. Established ideas which are gaining momentum attract large research grants, dominate conferences and can make careers. So radical hypotheses can struggle to be heard - they challenge the existing mind-set, at least at first can be difficult to understand and can, potentially, upset the on-going money/status/power apple cart.

Medical Hypotheses is one of the very few places where revolutionary medical views can be published. Based on the arguments above, this is a strong reason, in itself, for continuing the present policy of editorial choice of well argued, coherent, new and/or radical hypotheses. But, there are other reasons that Medical Hypotheses is an important conduit. From my perspective as a social scientist, the medical field is surprisingly a-theoretical, research is super-specialised, analysis is valued over synthesis and methods are more or less restricted to the experimental approach. I don’t imply that social science is more open, merely that the exclusions differ. In any science, theory and empirical evidence, analysis and synthesis, in-depth specialization and interdisciplinary cross fertilization should all matter. And the pursuit of knowledge through a variety of methods is fundamental, dependent, obviously, on the nature of the problem under investigation. The present state of play in medical science results in the exclusion of theoretical ideas through heavy emphasis on experimental methods. Surely any theory should first be assessed on the basis of coherence and capability to explain observed phenomena? I refer to the email extract below, the result of submitting work to a conventional, highly regarded peer reviewed medical journal.

‘I regret to inform you that we are unable to accept your paper for publication. Your proposals are interesting, but very speculative without empirical testing of derived hypotheses. A journal such as Medical Hypotheses is better suited for these two articles. I did not want to delay you in moving forward.’

I took this advice and Medical Hypotheses published the work. I wish to do empirical testing but as someone from outside the medical field I will be reliant on working with others. They are unlikely to take me seriously if I cannot get my work published. Also it is rare for any experiment to produce incontrovertible results, experiments rest on assumptions and results have to be interpreted. Without theories that make assumptions explicit and enable results to be interpreted experimental research becomes fragmented and goes nowhere. Theoretical and empirical work should go hand in hand – they are reliant on each other.

Medical Hypotheses provides a possibility for new, radical, theoretical and/or interdisciplinary work to be published. David Horrobin established the journal as non-peer review specifically to support ‘speculative’ work. It will be a travesty if this founding principle is overturned.

Sue Llewellyn
Professor, Faculty of Humanities
The University of Manchester
UK

Medical Hypotheses is a great journal which significantly influenced my carreer choice and research projects that I have conducted. I became really upset after reading your email.

Medical Hypotheses is a revolutionary journal which questions frequently the status quo. The fact that the journal is editorially-reviewed reinforces this point of view. In other words, when most journals are peer-reviewed, Medical Hypotheses questions if every journal should be like that.

I truly believe that the current review process of the journal is the one which best fits its purpose. If this will change, the journal name should also change and the publisher should give Medical Hypothesis a chance to look for another publisher. I am sure that there are plenty of publishers eager to be a partner of Medical Hypothesis.

Sincerely,

Arthur Kummer

Professor of Childhood and Adolescent Psychiatry
School of Medicine
Federal University of Minas Gerais.

Your recent communication concerning the future of Medical Hypotheses is beyond disturbing. Our group from the University of Toronto published two papers in Medical Hypotheses related to the potential of oral microbes (so called probiotics) to influence the human mental state. As a result of publication, the hypotheses have generated bench and clinical studies by various international investigators.

These hypotheses papers would not have seen the light of day in any traditional peer-review format - or at least not in a journal with a long history of credibility such as Medical Hypotheses. Under your leadership the current format Medical Hypotheses strikes a delicate balance between scientific integrity and out-of-the-box, thought provoking ideas. Any transition to a strict peer-review process will disturb this balance. Researchers, including our group, will be forced to look to less reputable journals for the mere publication of ideas.

A decision to make a transition to strict peer-review will be a decision to destroy one of the most remarkable journals ever to be printed.

I love the current policy of the Medical Hypotheses. It is a unique journal, and it is unique because it is not peer-reviewed.

1. Science never progresses without imagination, and academic breakthrough often begins from an immature idea. It is very important that we have a place to open our imagination, unproven idea, or non-evidence-based belief as an expert, and the Medical Hypotheses is probably the only forum for them. It is the editorial-review system that allows the submission of potentially revolutionary but unproven ideas without constraint, because all we have to do is to convince only the editor to accept our opinions. On the other hand, authors have to submit their articles far more prudently under the peer-review system, because they never hope their article be rejected by part-time reviewers not realizing the policy of the journal, by the reason that it is not logically “perfect”. The authors may avoid submitting logically “imperfect” opinions, but it is, I think, against the original policy of the journal.

2. Nowadays we have so many medical journals that we can find no time to follow those with similar concepts. The impact factor of the Medical Hypotheses is only 1.416, higher than average but never in the highest rank, and therefore if the Medical Hypotheses changes its style to nothing but a moderate and ordinary journal, I will prefer to save time the New England Journal of Medicine or the Lancet based on my own opinion that all the articles actually discuss their “hypotheses”. We do not want lower priority journals with similar contents. To survive, the Medical Hypotheses must not lose their originality as a free forum of candid discussion.

I am dismayed to learn of possible alteration in the review procedure for Medical Hypotheses. The journal is unique in providing an important service in the medical field. In order for your current method to work, it is important to have well qualified and versatile people in the editorial office. Results over the years have amply demonstrated that this is the case. Your journal displays high standards and the ability to competently review a variety of subjects, and recognize frontier areas. In my own case, our hypotheses, which would not have seen the light of day via the conventional route, are enjoying ever increasing acceptance and recognition over the years.

Please forward my comments to the appropriate authorities. I strongly urge that the proposed change does not occur.

Thank you for your message, which is rather alarming. Here is my vision, which you may share with Elsevier.

Hypotheses are the basis of science. Good research involves experiment that test a hypothesis. The more data points found that don't contradict the hypothesis, the more useful it becomes for building a theory. Or the hypthesis is invalidated. Well, we all know Poppers and science philosophy.

Peer review is a good thing. Scrutiny is needed in the validation of hypotheses before accepting them in a theoretical framework. But it does not work the other way around. A hypothesis should not be rejected, because it does not fit in an existing theoretical framework. As long as a hypothesis has not been tested, it is just that, a hypothesis. The value of hypotheses is that they provoke discussion. Is there existing data that supports or contradicts the hypothesis? What tests can you perform to which the hypothesis should hold up?

The Medical Hypotheses magazine is a valuable source for medical science. Medical hypotheses are very expensive to validate. It is good to openly discuss these hypotheses and contemplate their potential impact and ways to validate them. This is true especially for radical and revolutionary scientific ideas, which will never pass peer review. Some other sectors of science could well use their own Hypotheses magazine, for example Climate Science Hypotheses. This is a good way to keep discussions on hypotheses clearly separated from their peer-reviewed scientific validation.

Of course any published idea can be abused. My own publication in Medical Hypotheses was cited with a product, something that I am not too happy about. But it was a correct reference: "if van Deventer's hypothesis is true, then ...". And when people check the reference, they can exactly read where the uncertainties are with the hypothesis.

From my own experience I know that the editorial staff scrupulously checks submitted hypotheses. My own article was only accepted when I provided sufficient arguments why my hypothesis could be true and how the hypothesis could be put to the test.

In summary, I think that Medical Hypothesis should remain what it is, that is, a platform to present and discuss medical hypotheses.

I understand that Elsevier is considering changing Medical Hypotheses from editorial review to peer review. While I am completely in favor of the peer review system in general, I believe that editorial review has an important role to play in advancing biology and medicine. In my particular case, I have been studying human consciousness. This is a fascinating subject, and also quite daunting. Without Medical Hypotheses, I likely would not have been able to publish my early work, which likely would have been discouraging enough to prevent me from accomplishing as much as I have. I consider Medical Hypotheses to be a key partner in my progress.

I write in defense of keeping Medical Hypotheses exactly as it is. I write as an individual who has been published more than a dozen times by Medical Hypotheses when nobody else would publish me.

I think that the situation of Medical Hypotheses should be considered in context to Thomas Kuhn's description of the scientific process (he can be googled). Kuhn said that normal science has accepted a paradigm usually from scientific forebearers, and has the exclusive job of improving this paradigm by "puzzle-solving" studies.

Kuhn asserted that normal science rather invariably is negative to competing paradigms destructive of conventional wisdom. Also, normal scieance can be boxed into faililng to see problems with the accepted paradigm because nature is seen not as it is, but through the distorting lens of the accepted paradigm.

Kuhn said that major improvements in science come not from accumulation of studies, but by paradigm-change.

Unfortunately, medical scientists do not "see" the scientific process as defined by Kuhn. In my experience, medical operates by the inductive model. As current major positions are based on studies, only more studies can improve the current position.

This position essentially describes science as performance of studies - and does not allow for the possibility that a new paradigm might better explain a segment of science.

The story of Galileo is supposedly well known, and I suspect that most people believe that a Galileo problem can not occur today because the scientific process is well understood. I also suspect that most people do not understand why Galileo pushed the Copernican position. (Venus' full set of phases falsified the geocentric Ptolemaic theory - google this.)

I must admit that I speak from somebody with an unappreciated paradigm which challenges the basic conceptualization of heart attacks. Standard (PEER REVIEWED) journals invariably reject my papers, usually promptly and without outside reviews.

Incredibly, when rare outside reviews are obtained, they fail to evaluate the papers. Reviewers "think" in context to the accepted paradigm, and can not "see" the subject matter in context to the new paradigm. Kuhn said that those who believe in different paradigms live in different worlds, and sometimes the gulf between worlds is too great to allow understanding of the competing model.

If Medical Hypotheses, as presently constituted dies, they those with radical ideas are at the mercy of conventional thinkers.

Of course, there is nothing wrong with conventional thinking in context to reviewing results of studies. But I do insist that normal scientists fail to understand the nature of alternate paradigms, and do not understand how paradigms are evaluated - by verification/falsification techniques.

I knew David Horribin. I sent a paper to Medical Hypotheses, and David said he liked it, and invited me to lunch. As I live in the US, it was a while before I could take up the offer.

David Horribin knew full well that when radical hypotheses are published, there is a chance that some end up as "flat earth" ideas. But he was convinced that the more important issue was allowing publication of radical ideas unacceptable to "conventional wisdom."

Unfortunately, I was not surprised that the reaction of the "establishment" was to try to get Medical Hypotheses out of Medline because of a paper unacceptable to the establishment.

What is the difference of suppressing Medical Hypotheses and suppressing Galileo. In both cases, the suppressors were doing something "noble."

Those who believe that the AIDS article was nonsense should have written a paper which showed the foolishness of the article. If Medical Hypotheses would not publish a solid article which shows the imperfections of the AIDS paper, I would be quite unhappy with Medical Hypothses.

As I do not accept the standard paradigm for heart attacks, I have literally decades of experience in dealing with "normal science's" negativity to competing paradigms.

I have two goals: First to get an open and fair evaluation of my ideas by cardiology - which has not happened.

Secondly, to use my experience to make the point that Kuhn's description of the scientific process is valid. While most radical ideas might end up in the trashcan, they should not be suppressed!

I truly hope that Elsevier will not act in a manner similar to a pope of the early 17th century.

I was distressed to find out that there is an intention to transform “Medical Hypotheses” into an orthodox peer review journal. For many years, “Medical Hypotheses” has been a lighthouse of academic freedom.

I am sure that dishonest bureaucrats who run many academic institutions, departments, and centers around the world have been irritated by the fact that there is a journal that truly supports academic freedom and that they cannot control what is published in this outstanding Journal.

“Medical Hypotheses” is a great journal that has played a crucial role in the dissemination of scientific and medical information. “Medical Hypotheses” makes a fundamental contribution to biomedical progress and provides a voice that might otherwise never be heard. Any decision to change the format of manuscript review because of political considerations cannot be excused and can only lead to a higher level of censure than is already inherent within classical peer review. Peer review is problematic. Peer review makes the ability to publish vulnerable to control by elites, to personal jealousy, etc.

I sincerely hope that the leadership of Elsevier will make the right decision, and you will be able to continue doing your wonderful job as the Editor of this remarkable journal.

Your recent communication concerning the future of Medical Hypotheses is beyond disturbing. Our group from the University of Toronto published two papers in Medical Hypotheses related to the potential of oral microbes (so called probiotics) to influence the human mental state. As a result of publication, the hypotheses have generated bench and clinical studies by various international investigators.

These hypotheses papers would not have seen the light of day in any traditional peer-review format - or at least not in a journal with a long history of credibility such as Medical Hypotheses. Under your leadership the current format Medical Hypotheses strikes a delicate balance between scientific integrity and out-of-the-box, thought provoking ideas. Any transition to a strict peer-review process will disturb this balance. Researchers, including our group, will be forced to look to less reputable journals for the mere publication of ideas.

A decision to make a transition to strict peer-review will be a decision to destroy one of the most remarkable journals ever to be printed.

I recently became aware of the fact that Elsevier is thinking of altering the unique format of Medical Hypotheses (or perhaps closing it down). In my opinion, it would be a mistake to alter MH's unique format. Whereas I cannot speak to the contentious issues surrounding the AIDS-related papers (as I have not read them), I strongly value a journal that provides a forum for truly innovative (and at times speculative) ideas that might not find an appropriate outlet otherwise.

I have published two papers in Medical Hypotheses, both of which have received some attention. In one of my papers, I provided a Darwinian account of how economic conditions might affect global male-to-female suicide ratios. In a second paper, I highlighted sex-specific instantiations of OCD and argued that these are rooted in sex-specific problems of evolutionary import. I suppose that these works could have been published elsewhere but under the able editorial guidance of Dr. Bruce Charlton, I was able to publish them in a highly-read prestigious outlet in a quick time period. As someone who has published in journals in the social sciences (where the review process is exceptionally long and tedious), I can truly appreciate a journal that promotes such a rapid dissemination of novel ideas.

I hope that the relevant parties at Elsevier will reconsider their decision and keep MH as is. Why alter something that has worked well for 34 years? Many thanks for attending to this matter.

Regards,

Gad Saad

Dr. Gad Saad, Associate Professor

Concordia University Research Chair in Evolutionary Behavioral Sciences and Darwinian Consumption
John Molson School of Business
Concordia University
1455 de Maisonneuve Blvd. West
Montreal, QC, CANADA
H3G 1M8

I share your sentiments. Scientific publishing needs more than the meat and potatoes of peer-review. My own publications in Medical Hypotheses would never have seen the light of day through peer (i.e., consensus) review. Note, all have subsequently been well cited and in at least one case led to a whole new area of investigation. You are to be applauded for your work with the journal.